Awareness, Attitudes, and Concerns Regarding Heated Tobacco Products Among Physicians in Japan

A Scoping Review of Behavioural Studies on Heated Tobacco Products

Heated tobacco products (HTPs) are electronic devices that heat tobacco sticks to temperatures much lower than those which cause pyrolysis and combustion in cigarettes. While this electrical heating causes the formation of an inhalable aerosol which contains nicotine, the aerosol from HTPs contains significantly fewer and lower levels of the harmful and potentially harmful chemicals found in cigarette smoke. As a result, HTP use potentially conveys reduced risks to health compared to cigarette smoking. While this relative reduction in individual health risk is becoming clearer, what is less certain is the impact of HTPs on overall population‑level health, taking into account both the potential positive impact on adult smokers who completely switch to using HTPs and any unintended impacts such as use by tobacco non‑users and particularly by youth. The aim of this scoping review was to collate and evaluate the published scientific evidence to date, with a cut‑off of 1 January 2024, investigating the impact of HTPs on population‑level health. This evaluation suggests that HTP use is almost exclusively observed among those with a history of cigarette smoking, and there is a growing body of evidence for the ability of HTPs to provide support for adult smokers to transition away from cigarette smoking, in the absence of any significant "gateway" into tobacco use initiation. Many studies have reported a significant degree of dual use of cigarettes and HTPs, and efforts to assess the reasons for such patterns of use, whether these provide overall exposure reductions, and whether dual use acts as a bridge towards a complete transition away from cigarette smoking, requires further investigation. In addition, correction of the widespread and increasing misperceptions of HTPs among adult smokers is recommended to promote HTP uptake as a potentially less harmful alternative to smoking in this population.

Heated tobacco products- well known or well understood? A national cross-sectional study on knowledge, attitudes and usage in Pakistan

BACKGROUND

Heated tobacco products (HTPs) are reshaping the tobacco industry and just recently, a plan was sought to regularize HTPs in Pakistan. Pakistan provides an intriguing case study in this context, as tobacco use is deeply ingrained in public use. To ensure that future evidence-based policy recommendations are grounded in the public's knowledge, attitudes, and usage of HTPs, a nationwide survey must be conducted.

METHODS

A cross-sectional study was conducted using an online-based questionnaire nationwide in Pakistan. The questionnaire was validated and distributed through convenience sampling. The questionnaire assessed participants' knowledge, attitudes, and usage of HTPs. Descriptive statistics was used to describe participants' response and linear regression was performed at a p-value of < 0.05 using SPSS version 26.

RESULTS

In our sample of 1195 respondents (mean age of 33 years, 41.8% males and 58.2% females), 54.7% had previously heard about HTPs and 16.9% reported using HTPs at least once. Additionally, 38.24% were unsure of the legality of HTP use. Those with monthly household incomes of PKR 100,000 to 500,000, were more likely to have higher knowledge scores (OR:1.80[1.07-3.04]). On the other hand, males (OR:0.70 [0.55-0.89]) and respondents from Balochistan (OR:0.40 [0.22-0.71]) were more likely to have lower knowledge scores. The strongest motivators were the enjoyability of HTPs (55.73%) and usage as a cigarette alternative (54.64%), while the strongest deterrents were the negative health effects (82.68%) and potential for addiction (81.01%).

CONCLUSION

Our study underscores the need for awareness campaigns and interventions concerning HTPs, given prevalent preconceived notions and mixed attitudes among respondents. It was found that women and households with higher incomes scored higher on knowledge. Subjective enjoyment and a substitute for cigarettes were important motivators, but the most mentioned deterrents were the possibility of addiction and the detrimental effects on health. These insights form the basis for informed policy making for non-cigarette tobacco products.

Prevalence, knowledge, and concerns regarding the use of heated tobacco products and electronic cigarettes among young Japanese physicians

INTRODUCTION

Heated tobacco products (HTPs) and e-cigarettes (ECs) have gained traction as alternatives for harm reduction, especially in Japan. In particular, the use of HTPs is rapidly gaining popularity among young adults in Japan, with a prevalence of 10.9% in 2020. Despite uncertainties regarding the health effects of HTPs and ECs, concerns regarding nicotine and carcinogens persist. Although physicians play a vital role in smoking cessation, they lack awareness and concerns regarding HTPs. This study aimed to assess the prevalence, knowledge, and concerns regarding HTPs and ECs among young Japanese physicians.

METHODS

A cross-sectional online survey was conducted in 2021 with 529 young Japanese physicians aged 24-39 years. Parameters assessed included awareness, smoking status, knowledge of HTPs and ECs, and concerns related to HTPs. Statistical analyses were conducted to assess prevalence, knowledge, and concerns by smoking status using the chi-squared test and logistic regression.

RESULTS

Most participants were aware of HTPs (89.0%) and ECs (71.3%). Young male physicians preferred HTPs, while females favored ECs. Primary sources of information included newspapers and stories (56.8%), and TV (37.4%). Non-smokers (89.0%) demonstrated limited knowledge of these products. Concerns were highest and lowest among non-smokers and HTP users, respectively, with safety concerns being the most prevalent.

CONCLUSIONS

Young physicians exhibited lower smoking rates than the general population, but HTP use was prominent among young male physicians. Concerns varied based on smoking status, indicating the need to address these issues among healthcare professionals. Despite high awareness, knowledge gaps, particularly among non-smokers, highlight the importance of public health and educational campaigns to disseminate knowledge among physicians, regardless of medical specialty.

Smoking Status and Risk Awareness of Heated Tobacco Product Use among General Dental Practitioners Belonging to the Aichi Dental Association, Japan

The awareness of healthcare practitioners concerning heated tobacco product (HTP) use risks has been evaluated; however, few studies have investigated general dental practitioners’ awareness regarding HTP-use risks. In this cross-sectional study, we investigated dentists’ awareness of the risks of smoking, particularly HTP use. A self-administered questionnaire, including eight questions on conventional cigarette and HTP smoking/using status and both knowledge and awareness of HTP-use risks, was posted to 3883 dentists belonging to the Aichi Dental Association, Japan, in August 2019. Statistical analysis was performed using the Statistical Package for Social Sciences; statistical significance was set at p < 0.05. We analyzed the data of 1317 dentists (participation rate, 41.6%). The study group included cigarette smokers (11.5%) and HTP users (8.5%), among whom 41.1% were dual users. HTP users were more likely than never smokers/users to correctly perceive HTP-use risks (p < 0.05). This study indicates that in Japan, the proportion of HTP users is higher than that of the general population. It is important to educate not only smokers/users but also never smokers/users on the risks of smoking and using HTPs. Smoking cessation, including ceasing HTP use, and aiming to quit smoking and HTP use among dentists would contribute to appropriate smoking cessation among patients.